The Care Quality Commission risks being distracted from its core role of regulating health and adult social care services by government plans to extend its responsibilities, the National Audit Office warned today.
The Department of Health should reassess plans to make the CQC responsible for service user watchdog Healthwatch England and for overseeing fertility clinics to ensure the regulator has the capacity to take on these functions, the NAO said.
The CQC is also due to take on responsibility for registering GPs and out-of-hours health providers next year, and the NAO warned that its resourcing requirements for the long-term were uncertain.
The NAO also criticised the CQC's approach to managing its performance, saying they were largely based on quantity-based measures of activity, such as the number of inspections, rather than indicators of quality. It said data were not available on key measures such as the types of enforcement action taken against providers.
There was also a lack of clarity about what constituted good quality regulation, the NAO said, which contributed to a gap between the high public expectations of the CQC in ensuring that services were safe, and what it could actually deliver.
The report also said CQC inspectors needed more support in making sound and consistent judgements about adult social care services in particular, including because of a lack of data.
The NAO concluded that the CQC was not delivering value for money but said responsibility for this situation was shared between the regulator and the DH.
It noted that the CQC had been set up on a reduced budget than its three predecessor regulators, but with greater responsibilities, such as regulating NHS providers. More recently, the CQC was prevented from filling vacancies quickly by government-imposed constraints on recruitment, the NAO said.
Responding to the report, CQC chief executive Cynthia Bower said: “As the NAO report makes clear, we faced a difficult task. We had to bring together the work of three organisations and bring in a new model of regulating health and adult social care. Not everything has gone smoothly, but we have learned, reviewed what we do and made changes – often with support of others involved in health and social care.
"We are a young organisation and we are still evolving - but I firmly believe that we are making real progress. In October alone, we conducted more than 1,400 unannounced inspections. In the last three months we have recruited and trained over 100 additional inspectors.
The report follows news that the DH had expected a request from the CQC to increase its budget for next year to help it fund annual inspections for services.
The NAO study comes at the end of a turbulent year for the regulator in which it has:
● Been slammed by the House of Commons health select committee for "distorted priorities" for switching resources from inspection to re-registering adult care providers.
● Admitted failing patients at Winterbourne View Hospital in Bristol by not responding to whistleblower Terry Bryan, who reported abusive practice.
● Faced public calls for chief executive Cynthia Bower to step down from board member Kay Sheldon because of an alleged failure of leadership.
The NAO's recommendations included:
● For the DH and the CQC to define, as far as possible in measurable terms, the outcomes against which the CQC should be measured.
● For the CQC to provide inspectors with better support to make judgements about the quality of services, including by identifying more sources of data on adult social care.
● For the DH and the CQC to continue to monitor its resource position.
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